In-Depth Analysis and Investigative Reports

Drops of water, gallons of misery

By the time Mary Nsiah Boamah, 29, found out what the bumps on her 3-year-old son's hand meant, it was too late.

She noticed them in December. It took three months, five hospitals and $547 - nearly a year's income - for the plantain farmer to find a doctor who recognized the symptoms of buruli ulcer.

Buruli - Boamah had never heard of the flesh-eating disease. She never suspected it might lurk in the river where she gathered water and washed her only child, or that they would end up in Agroyesum, at St. Martin's Catholic Hospital, having his hand amputated.

"The child never asks what's wrong, just looks at his hand and doesn't know," Boamah said in her Ghanaian language, Twi.

St. Martin's became a national buruli treatment center after witnessing Ghana's first outbreak a decade ago. The village hospital at the end of a dirt jungle road attracted support from the World Health Organization, the U.S. Centers for Disease Control and Prevention, and Syracuse. In January, the Roman Catholic Diocese of Syracuse plans to begin sending medical supplies to help buruli patients at St. Martin's.

Doctors don't know much about buruli. There's no known cause, although they suspect standing water. Buruli is not contagious and rarely fatal, but there's no cure or vaccine. A symptom of lacking hygiene, health care and clean water in developing countries, buruli has spread to more than 27 nations with more than 6,000 cases reported last year. About a sixth of those infections were in Ghana.

Researchers say buruli is considered a "neglected disease" by the WHO because there's no money or plans to find a cure or develop a vaccine, despite its reach 27 countries report infections in Africa, Asia, Australia and South America.

Dr. Kingsley Asiedu, the WHO's medical officer for buruli, is focusing on prevention. He said researchers have found buruli cases clustered around ponds and rivers, including the Offin River in Boamah's village. Doctors tell villagers to use wells and avoid standing water.

"This is our thinking: That if people can reduce contact with rivers and stagnant ponds and swampy areas, where some people have no option but to go for water for daily life, then there could be some chance for reducing the occurrence of the disease," he said.

Boamah walked the length of two football fields to fetch water from the Offin River every day. She usually found children playing in the river, but kept Gyamfi strapped to her back he was too small to play, she said. Still, she bathed him in the water and fed it to him, never thinking it could harm him.

Poor, rural children such as Gyamfi are particularly at risk for buruli, said Dr. Clare Dykewicz, a CDC medical epidemiologist. Children are more likely to be near standing water, swimming or wading without protective clothing, she said, which studies show puts them at risk.

Dykewicz visited St. Martin's in January. She met the 37 nurse assistants, 14 nurses and the single doctor operating on buruli patients. The buruli specialist has since left. Dykewicz called the staff excellent, their working conditions cruel. With an annual budget of $866,520, St. Martin's spends $72,210 on buruli. Most is spent on operations and antibiotics to keep infections from spreading. Gyamfi, for example, receives four antibiotics a day at a monthly cost of $35. Although Ghana's government reimburses the hospital for buruli treatments, payment takes six months to a year, Administrator John Bawa said.

At St. Martin's, painkillers such as aspirin are a luxury.

"So when they do dressing changes, which are going to be painful, they can't even afford what we would consider over-the-counter pain relief," Dykewicz said.

"Nothing that I saw would even meet the standard for a field hospital," said Ralph Jones, director of the diocese's Office for Black Catholic Ministry, who spent 27 years in the U.S. military.

Jones remembers walking the hospital's open-air halls, from the operating room with its single fluorescent light to the men's buruli ward, a concrete box of a room with worn screens, fans and faces emerging from the darkness.

With Dennis Manning, who heads Syracuse's Catholic Relief Services office, Jones entered the buruli children's ward. He saw mothers curled on the floor, others holding babies. He thought of Syracuse's Crouse Hospital, where "the child is in a sterile environment with all this equipment around them, and here we come to this room with the mothers holding the children, the only comfort they had."

Gyamfi Boamah writhes in his mother's arms. A nurse is replacing the gauze on his amputated arm, exposing red, raw flesh. He cries to his mother that he is dying.

Boamah, nine months pregnant, holds the boy against her belly. A tear rolls down her cheek.

They will repeat this painful routine twice a day for the next three months, nurse Paulina Opei says.

Of the 120 beds at St. Martin's, half are occupied by buruli patients, more than half of them children. As the children's ward swelled last year, the hospital assigned a nurse to teach 22 students, ages 2 to 14.

Children at the hospital come to class on braces and crutches with bandaged necks, ankles and hands. Sometimes relatives visit and are afraid to enter the hospital, drink the water or touch infected children, says teacher Naomi Appiah, 26.

Gyamfi's mother isn't afraid. She cooks for her son in the hospital's grassy courtyard, drinks from the communal well and sleeps on the concrete floor.

"The bed," she says, "is for the child."

After Jones returned to Syracuse, he contacted InterVol, a Rochester-based nonprofit that sends surplus medical supplies to developing countries. The group, which has a branch in Buffalo, already gathered supplies from St. Joseph's and University hospitals. Jones offered to start a Syracuse branch by reaching out to more hospitals.

In January, InterVol Syracuse plans to send its first 40-foot container of medical supplies worth more than $100,000 to St. Martin's, Manning said.

Jones hopes the shipments - including gauze, syringes, sterile gloves and sutures - allow St. Martin's to spend more on treating and preventing buruli.

Syracuse money already flows to the hospital through an annual March collection for Catholic Relief Services that last year raised $16,900, Manning said. Syracuse keeps 25 percent of the collection for local projects, then gives the rest to the Baltimore-based group for overseas aid. Catholic Relief Services spent $13.4 million in Ghana last year, including $19,360 feeding15,000 patients at St. Martin's and other hospitals, said spokeswoman Hilary Roxe.

The visit to St. Martin's inspired Jones and Manning to offer $10,000 in local CRS money collected over the years to the hospital's diocese and dioceses in each of the four other African countries that sent priests to Syracuse.

Of the seven projects the diocese sponsors in Africa, five are water-related, Manning said. After visiting Ghana, he understands why.

"There's just so much time devoted to getting water each day for so many folks and then the water they're getting is not the best," Manning said.

Manning plans to meet with the African priests early next month to evaluate the projects and gather information for parishoners.

The greatest need in St. Martin's Obuasi diocese, according to priests and residents, is clean water. More than half of Ghana's rural population, 6.3 million people, don't have well water, according to the most recent United Nations study in 2000.

Agroyesum's 2,005 residents depend on two wells: a hand pump just off the main dirt road and a 45-year-old electrical pump at the hospital. Both cost villagers 100 Ghanaian cedis per two-gallon bucket, about a cent. The town council saves the money, $500 annually, for tap maintenance.

St. Martin's well is dying. Behind the hospital, water seeps from its 4,000-gallon metal and concrete tank and from three 2,000-gallon plastic tanks and flows down its 20-foot metal supports.

There, the hospital administrator says, see the rust? That's not the only problem, the hospital's plumber says - the well isn't pumping. The electricity's gone out again, he says, a biweekly problem. St. Martin's officials don't have $12,000 to replace the well, he says. They asked the Ghanaian government for help last year and were told to wait.

Obuasi Bishop Thomas Mensah says he wants to help, but he's using the Syracuse money for more pressing needs. He has to train seminarians and supervise about 600 churches and 199 schools. He plans to build a $12,000 well and 500-bed orphanage in Obuasi, about an hour from the hospital. He spent $3,500 of the Syracuse money to send three seminarians to school.

About a half-mile from the proposed well site, where the busy Obuasi Road becomes a bridge, children clamber down its sides into a small river.

"They come here, they bathe in it, they do everything in it and then they take the water," says the Rev. Matthew Tuffour, a priest in the diocese.

Aboagye Queenking, 18, stands on the bridge pointing down at a dozen children on the riverbank. A girl wades into the river, dips her blue plastic cup in the brown water and drinks. They say the water tastes salty, he says, that it gives you diarrhea. But the children can't afford to pay 500 cedis, about 5 cents, for a bucket from a nearby well, he says.

"We don't have the people to do it for us, the well water," he says, looking back at the children, "Every day, they drink."